Provider Demographics
NPI:1275032369
Name:GRANADA HOUSE, INC.
Entity Type:Organization
Organization Name:GRANADA HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-254-2923
Mailing Address - Street 1:70 ADAMSON ST
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1306
Mailing Address - Country:US
Mailing Address - Phone:617-254-2923
Mailing Address - Fax:617-787-3820
Practice Address - Street 1:70 ADAMSON ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1306
Practice Address - Country:US
Practice Address - Phone:617-254-2923
Practice Address - Fax:617-787-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0269OtherRESIDENTIAL REHABILITATION SERVICES LICENSE